One of the major issues of the recent presidential campaign was the fate of Obamacare. Republicans have been trying for the past six years to “repeal” the health insurance structure adopted in 2010.

But the election of Donald Trump as president won’t necessarily mean a full “repeal” of the law. Doing that would throw both the insurance community and health care industry into financial chaos.

More likely is for certain parts of the law to be kept, other parts abolished and some new provisions put into place.

Here’s a rundown of some of the key areas that will be part of that debate:

•MANDATE — Obamacare mandates that everyone in the nation have health insurance, or pay a penalty. The idea behind that was to force younger, healthier individuals into the system as a way to subsidize older, sicker people. But the mandate isn’t liked by many and will probably go away under the coming reforms. That will leave the insurance pools with sicker people, which in turn could force rates even higher.

•PRE-EXISTING CONDITIONS — Before Obamacare, insurance firms could exclude sick people or in some cases, kick off people who developed an expensive illness. That can’t be done today. This part of the law is very popular and will likely be kept, but look for insurance firms to try to make it go away. Insurance companies would love to have the ability to get rid of their sickest enrollees.

•AGE 26 COVERAGE — Keeping children on an adult’s policy until age 26 is also popular. Republicans probably won’t seek to change this, either.

•STATE EXCHANGES — These are the heart of Obamacare’s system and will likely go away, especially if the mandate goes away. The individual market in the exchanges is dying. Insurance firms are fleeing it because it’s bringing in sicker patients and not drawing in younger, healthier people. If this goes away, so will the subsidies for poor people to purchase insurance.

•GENDER DISCRIMINATION — Before Obamacare, insurance firms could charge one gender, usually women, more for insurance. That’s no longer possible, but might change under reform.

•COMPANY INSURANCE — Under Obamacare, firms with 50 or more employees were mandated to offer health insurance. That threshold may go up to 100 or 150 employees to give small businesses a break.

•MANDATED COVERAGES — Obamacare more or less structured insurance policies by forcing insurance companies to cover certain things. Some of those had to be free, such as birth control for women. Look for some of this to change under reform so that insurance companies have more freedom to include or exclude certain coverages. The downside will be that comparing insurance policies could get more complicated and will require more consumer study.

As both a small business owner and someone who has a chronic illness that requires a lot of medical interventions, I see this issue as both a businessman and as a healthcare consumer.

On the business side, dealing with health insurance has gotten to be more complex and more expensive. Small companies like ours don’t have enough employees to negotiate cheaper plans or to be partly self-insured. And the Obamacare paperwork has increased to a point that is crazy. This year, we had to switch insurance firms due to a major hike in our rates. That is a pain for both management and employees.
As a patient, however, having health insurance is not a luxury, it’s necessary. My total healthcare cost over the past year was probably over $150,000 for scans, medications, treatments, biopsies, etc. For six months, I was taking a daily pill that cost $10,000 per month. A recent group of infusions at Emory Hospital was over $40,000.

No individual can afford that kind of medical expense. Without insurance, patients with chronic medical conditions would go bankrupt, or perhaps face dying from not getting treatment.

Before Obamacare, the nation’s healthcare system was in disarray. Insurance firms were dropping sick patients and jacking rates up at a pretty fast clip.

Obamacare did address some of those issues, but it didn’t bring the cost down as promised. Younger, healthier people didn’t buy medical insurance despite the mandate. And without younger people in the insurance pool, the entire house of cards will collapse.

That’s going to be the biggest problem Republicans face in trying to redo Obamacare. Health insurance works by having healthier patients in the pool to subsidize sicker patients. Over the long term, those younger patients will themselves require more medical care and another group of younger people will enter the system to subsidize their costs.

But if younger people don’t buy health insurance, the entire health insurance system will collapse. It cannot be sustained by only having sicker patients in the market. The consequence of that is even higher premiums which in turn pushes out even more people from the pool, especially those who don’t think they’ll need much healthcare. Thus begins a “death spiral” that collapses the entire system.

How will Republicans address that fundamental issue of bringing younger people into the insurance market? And how will Congress restructure the market that allows for cheaper policies yet at the same time makes sure insurance firms don’t deny coverage to those with pre-existing conditions?

Healthcare is not the kind of system where traditional capitalism and market forces of supply and demand work very well. While there has been a push for patients to do more “shopping around” in the healthcare market, that is more theory than practice. Healthcare isn’t like buying a new car.

If you are sick, you’re going to do what your doctor suggests most of the time without asking about the cost. And jumping around from doctor to doctor or hospital to hospital isn’t possible for the chronically ill who need consistent care and clear communication between doctors and related providers.

As for insurance companies, without some controls they can be abusive of consumers. Insurance companies aren’t in the business of providing healthcare, they’re in the business of making money for shareholders. They would love nothing more right now than for the Republican Congress to allow them to once again dump sick patients from their pools and to be able to again deny coverage based on pre-existing conditions as was done before Obamacare.

Fixing the U.S. healthcare insurance system isn’t as easy as simply “repealing” Obamacare. The issues are extremely complex and the potential impact is often a matter of life or death for thousands of people.

And the issue doesn’t affect all Americans equally. The poor have Medicaid. The elderly have Medicare.

It’s the working middle class that is really being hit hard by the rising cost of healthcare and the rising cost of buying health insurance.

I don’t have the answer to fixing all of that. President Obama didn’t have the answer. And I suspect the Republican Congress may not either.

Reforming Obamacare will bring out all the heavy political guns. Healthcare and insurance lobbyists will flood Washington for the fight.

As a businessman, I hope they figure out how to lower my firm’s healthcare costs.

As a patient, I hope they don’t dump me out of the system that I need in order to stay alive.

As an American, I hope they don’t bankrupt the economy.

Mike Buffington is co-publisher of Mainstreet Newspapers, Inc. He can be reached at mike@mainstreemnews.com.

The eight hundred pound gorilla in the room is the five lobbyist from the medical profession for each member of congress. Three hundred dollars for fourteen antibiotic capsules is right up there with highway robbery. Cost needs to be brought under control. The medical insurance companies disallow what is charged and the co-pay is a killer. This is nothing but transfer of wealth and exploitation of the weak and sick.

I've come to the conclusion that, because health care like education and roads does not lend itself to market forces, we should just go all in for single-payer and be done with it. Just expand Medicare for all (dump Medicaid) on the basis of as much coverage as the nation can afford and no more; the devil there would be in the details, of course. If people want more coverage, they can buy supplemental policies from the existing insurance companies to keep those entities in business. Then we work on strategies to control costs which an expanded Medicare would have a lot of power to influence. Let big business and corporations rip us off in other categories, but not in health care.

Competition it needed to bring down cost. Obama's way is socialized government health care. A rudamary look around the world we see the result of socialism healthcare and all other things it tries to provide. The army is middle class, some very rich and the poor at starvation levels.

True competition works our in the long run, until some wise "Berny" type stirs up soft children in liberal colleges that have not been taught actual history, demands free everything.

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